Right vs left side thoracoscopic sympathectomy: effects of CO2 insufflation on haemodynamics

Currently, few reports of the haemodynamic impact of intrapleural CO2 insufflation in the clinical setting are available. Therefore, we conducted the present study to compare the haemodynamic changes between right and left side thoracoscopic sympathectomy (TS) for treatment of palmar hyperhidrosis (PH) under general anaesthesia.

20 adult patients (17 males) undergoing TS were randomly allocated to two groups (each 10); group A, right side and group B, left side TS procedures were performed under general anaesthesia with single-lumen endotracheal tube. Besides the routine monitoring of vital signs, non-invasive cardiac output monitor (NICO) was used to record the stroke volume (SV), cardiac output (CO) and cardiac index (CI). Intrapleural CO2 insufflation was used. Anaesthesia was maintained with 1 MAC sevoflurane in 50% nitrous oxide in oxygen with incremental doses of sufentanil and atracurium when required. Haemodynamic parameters were obtained every 3 min then averaged over the time of surgery at phases; I) after tracheal intubation, II) after CO2 insufflation and III) after CO2 deflation.

The CO, CI and SV showed decreased trend in both groups during phase II compared to phase I with significant differences (P < 0.05). Comparing the CO and CI variables revealed lower values in group A compared to group B but with non-significant differences (P > 0.05). While the SV variable showed significant low value in group A compared to group B (P < 0.05).

Compared to left side TS, direct compression by CO2 against the venae cava and right atrium and ventricle during right side TS caused reduction of the venous return and hence low CO, CI and SV.